MEDICARE: CARDIOTHORACIC SURGEONS OF THE SOUTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	15365R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881737104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOTHORACIC SURGEONS OF THE SOUTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3084
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70602-3084
Country	:	US
Telephone Number	:	337-436-7560
Fax Number	:	337-433-9861

Provider Business Practice Location Address
First Line	:	1605 FOSTER ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5815
Country	:	US
Telephone Number	:	337-439-5800
Fax Number	:	337-439-0003

Authorized Official
Title or Position	:	OWNER
Name	:	DR. XAVIER RENE MOUSSET
Credential	:	MD
Telephone Number	:	337-439-5800

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	05/27/2008

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